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MSK > Spine (Degeneration, Lower back pain and disc prolapse) > Flashcards

Spine (Degeneration, Lower back pain and disc prolapse) Flashcards

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1
Q

What type of joints are faecet joints of the lumbar spine and what movements do they allow?

A

True synovial joints

Mainly flexion and extension

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2
Q

What types of joints are intervertebral discs of lumbar spine and what movements do they allow?

A

Secondary cartilaginous joints

Movement between vertebrae

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3
Q

Where is the anterior longitudinal ligament (ALL)?

A

Along the front of the vertebral bodies

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4
Q

Where is the posterior longuitdinal ligament (PLL)?

A

Along the backs of the vertebral bodies i.e. front of the spinal canal

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5
Q

Where is the ligamentum flavum?

A

Between laminae

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6
Q

Where is the interspinous and supraspinous ligament found?

A

Between spinous processes

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7
Q

Where is the intertransverse ligament found?

A

Between transverse processes

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8
Q

Where is the pain worse in nerve root pain?

A

Limb pain is worse than back pain

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9
Q

Presentation of nerve root pain

A

Pain (back, limbs)
Root tension signs
Root compression signs

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10
Q

Treatment of nerve root pain

A

most settle about 90% in 3 months
physio
strong analgesia
MRI

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11
Q

Normal ageing process of the spine

A

decreased water content of discs
disc space narrowing
“degenerative changes” on X rays
degeneration changes in faecet joints

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12
Q

What is the ageing process of the spine aggrevated by?

A

Smoking

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13
Q

Where are degenerative changes seen in cervical and lumbar spondylosis (OA)?

A

faecet joints
discs
ligaments

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14
Q

What can severe cervical/lumbar spondylosis cause?

A

Can compress the whole cord (not just the nerve roots) causing myelopathy
- UMN signs in limbs (increased tone, brisk reflexes etc)

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15
Q

What is lumbar spondylosis?

A

OA of faecet and disc joints (+degeneration of ligaments etc)

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16
Q

Who is spinal claudication/stenosis very common in?

A

patients > 60 y/o

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17
Q

Types of spinal claudication/stenosis

A

Lateral recess stenosis
Central stenosis
Foraminal stenosis

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18
Q

Treatment of lateral recess stenosis

A

non operative
nerve root injection
epidural injection
surgery

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19
Q

Treatment of central stenosis

A

non operative
epidural steroid injection
surgery

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20
Q

Treatment for foraminal stenosis

A

non-operative
nerve root injection
epidural injecton
surgery

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21
Q

Most common cause of spinal cord injuries

A

RTAs
sports and recreational activities
falls

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22
Q

Criteria/presentation of a complete injury (grade A) to spinal cord

A

No motor or sensory function
no anal squeeze
no sacral sensation
no chance of recovery

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23
Q

What is the grading system for spinal cord injuries?

A

ASIA grading

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24
Q

Presentation of incomplete injury of spinal cord

A

Some function still present below the site of the injury

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25
ASIA grade A
Complete | no sensory or motor function preserved in sacral segments S4-5
26
ASIA grade B
Incomplete | Sensory but not motor function preserved below neurological level and extending through sacral segments S4-5
27
ASIA grade C
Incomplete | motor function preserved below the neurological level; majority of key muscles have grade < 3
28
ASIA grade D
Incomplete | Motor function preserved below the neurological level; majority of key muscles have a grade > 3
29
ASIA grade E
normal motor and sensory function
30
Definition of tetraplegia/quadraplegia
Partial or total loss of use of all 4 limbs and the trunk
31
Definition of paraplegia
Partial or total loss of the use of the lower limbs
32
What can cause tertraplegia/quadriplegia?
Cervical fractures
33
What can cause paraplegia?
Thoracic/lumbar fractures
34
Examples of partial cord syndromes
central cord syndrome anterior cord syndrome brown-sequard syndrome
35
Features of central cord syndrome
``` older patients (arthritic neck) hyperextension injury central cervical tracts more involved weakness of arms > legs perianal sensation and lower extremity power conserved ```
36
Features of anterior cord syndrome
``` Hyperflexion injury anterior compression fracture damaged anterior spinal artery fine touch and proprioception preserved profound weakness ```
37
Features of brown - sequard syndrome
Hemisection of the cord Penetrating injuries Paralysis of affected side (corticospinal) Loss of proprioception and fine touch discrimination (dorsal columns) Pain and temp loss on opposite side below lesion (spinothalamic)
38
Treatment of spinal cord injuries
KEY IS TO PREVENT SECONDARY INSULT ABCD - airway = C spine control - breathing = ventilation + O2, concomitant chest injuries - circulation = IV fluids, consider neurogenic shock - disability = Assess neurological function ATLS = advanced trauma life support X rays CT MRI - if neurological deficit or children Surgical fixation for unstable fractures
39
Long term management of spinal cord injury
spinal cord injury unit OT psychological support urological/sexual counselling
40
Definition of spinal shock
A type of shock that causes a temporary reduction of or loss of reflexes following a spinal cord injury. Transient depression of the cord function below the level of the injury
41
Presentation of spinal shock
flaccid paralysis | areflexia (muscles overreact to stimuli)
42
Symptoms of neurogenic shock
hypotension bradycardia hypothermia
43
What is neurogenic shock secondary to?
Disruption of sympathetic outflow
44
Definition of neurogenic shock
A type of shock resulting in low BP and slowed HR which is attributed to the disruption of autonomic pathways within the spinal cord
45
Two types of lumbar disc prolapse
lateral disc protrusion | central disc protrusion
46
What position are disc prolapses usually?
Postero-lateral
47
What In the lumbar disc prolapse can cause cord/nerve root compression?
Annulus may tear + nucleus prolapse
48
Types of disc problems
Buldge (generalised) - mainly asymptomatic Protrusion = annulus weakned but still intact Extrusion = thought anulus but incontinuity sequestrian = dessicated sic material free in canal
49
Where are cervical dis prolapses most common?
C5/6
50
Least common area of the spine for disc prolapses
Thoracic spine as doesn't move as much
51
Most common thoracic area for disc prolapse
T11/12
52
Where are lumbar disc prolapses most common?
L4/5, then L5/S1, then L3/4
53
What is cauda equina syndrome a result of?
compression of the cauda equina
54
Management of cauda equina syndrome
URGENT MRI scan | emergency operation within 48 hours of onset - dissectomy
55
Causes of cauda equina syndrome
``` Central lumbar disc prolapse - COMMONEST tumours trauma - burst or chance fracture disc - spinal stenosis infection - epidural abscess iatrogenic - spinal surgery/manipulation - spinal epidural infection ```
56
Presentation of cauda equina syndrome
``` Sudden - injury or precipitating event Bilateral buttock and leg pain Varying dyskinesia and weakness Urinary retention +/- incontinence overflow bowel dysfunction saddle anaesthesia (perianal loss of sensation) loss of anal tone loss of anal reflex ```
57
investigation of cauda equina syndrome
MRI | if contraindicated = lumbar CT myelogram
58
What pathology does a positive straight leg raise test indicate?
Sciatic nerve pain
59
Red flags for back pain
``` Thoracic back pain Age < 20 or > 55 Non mechanical pain Pain worse when supine Night pain Weight loss Pain associated with systemic illness Presence of neurological signs Past medical history of cancer or HIV Immunosuppression or steriod use IV drug use Structural deformity ```
60
What does a prolapsed lumbar disc usually present with?
Clear dermatomal leg pain associated with neurological deficits
61
Features of a prolapsed disc
Leg pain usually worse than back | Pain often worse when sitting
62
Features of an L3 root compression
Sensory loss over anterior thigh Weak quads Reduced knee reflex Positive femoral stretch test
63
Features of L4 root compression
Sensor loss over anterior aspect of knee Weak quads Reduced knee reflex Positive femoral stretch test
64
Features of L5 root compression
Sensory loss dorsum of foot Weakness in foot and big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test
65
Features of S1 root compression
Sensory loss posterolateral aspect of leg and lateral aspect of foot Weakness in plantar flexor of foot Reduced ankle reflex Positive sciatic nerve stretch test
66
Management of lumbar disc prolapse
Analgesia Physio / exercises If symptoms persistent i.e. beyond 4 - 9 weeks then consideration of MRI
67
What is discitis?
An infection of the intervertebral space
68
Presentation of discitis
Back pain Fever / rigors / sepsis Neurological features e.g. change in lower limb signs (if epidural abscess develops)
69
Causes of discitis
Bacterial (Staph A most common) Viral TB Aseptic
70
Investigations of discitis
MRI | CT guided biopsy may be needed to guide Ax Tx
71
Treatment of discitis
IV Antibiotics 6 - 8 weeks
72
Complications of discitis
Sepsis | Epidural abscess
73
What % of sciatica resolves spontaneously with conservative treatment within 3 months?
90%
74
When would sciatica be routinely referred to spinal surgery?
Failure of conservative treatment after 4 - 6 weeks

MSK (25 decks)

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